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Dr. Sarah Redding and her late husband, Dr. Mark Redding, developed the original Pathways Model in 2001. Their positive experience collaborating with community health workers (CHWs) in Kotzebue, Alaska and Baltimore, Maryland led them to start the Community Health Access Project (CHAP) in Mansfield, Ohio. CHAP developed a training curriculum and hired CHWs from census tracts experiencing poor birth outcomes. Looking at the data showed that the disparate birth outcomes weren’t improving. Based on feedback and learning from the CHWs, Pathways were created as a tool to identify risk factors faced by their participants. Each Pathway identified one individually modifiable risk factor and the steps to mitigate that risk. Pathways are designed to end in a measurable outcome that is meaningful to the person served. CHWs, using Pathways, were able to show a 60 percent reduction in low-birth-weight rates.


Realizing that one nonprofit organization could not address health disparities alone, Mark and Sarah conceptualized the Pathways Community HUB Institute® Model. The pilot Pathways Community HUB (PCH) in Mansfield linked agencies employing CHWs together into a network with a PCH at the center. All CHWs used Pathways to identify and mitigate risk factors. In addition to Pathways, the PCHI® Model developed an outcome-based payment strategy to sustainably support the CHWs work. The PCHI Model provided standardized guidance to CHWs to identify and address barriers to care and eliminate risk factors while aligning payment contracts to completed Pathways (outcomes). Improvements in population level health and reduction in health disparities followed.

As the Reddings shared their passion across the country, communities attempted to replicate the PCHI Model with varying levels of success. That experience led to the founding of the Pathways Community HUB Institute® (PCHI) in 2015. PCHI partnered with the Georgia Health Policy Center, the Rockville Institute, and Communities Joined in Action to pilot the first PCH Certification Program in 2016. In 2020, the Pathways Community HUB Institute Model began a major update based on feedback from stakeholders--community health workers, certified Pathways Community HUBs and payers. This update is being released in 2022 through a licensing strategy to PCHI Model certified entities to protect the integrity of the PCHI Model. This update includes a standardized data model, data dictionary, a value-based payment strategy defined by outcome-based units, as well as demographic and visit forms, and 21 Standard Pathways. The PCHI Model certification program has expanded to include not only Pathways Community HUBs, but also Pathways Agencies, Technology Vendors and Community Health Worker Instructors.

Due to the tremendous interest in the PCHI Model, in 2021 PCHI named its first President & CEO, Jan Ruma, who among other accomplishments, previously led the first certified Pathways Community HUB in Ohio. This is the largest operating PCH in the country and contracts with all of Ohio Medicaid plans. Jan and Dr. Redding work side-by-side with the support of the PCHI Board of Directors to scale the PCHI Model across the country with their capable team and committed community partners.

The original Pathways Model was developed by Mark & Sarah Redding in 2001


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